Superior Rectal Artery Pseudoaneurysm Caused by Chronic Rectal Trauma: A Rare and Life-Threatening Source of Lower Gastrointestinal Bleeding

Lower gastrointestinal bleeding is a frequent cause of emergency department admission and may range from self-limiting conditions to life-threatening hemorrhage. While most cases originate from benign anorectal or colonic pathology, vascular etiologies are rare and often underrecognized, particularly in patients without a history of acute trauma or prior intervention. Superior rectal artery pseudoaneurysm represents an exceptionally uncommon vascular cause of lower gastrointestinal bleeding and poses a significant diagnostic challenge due to its nonspecific clinical presentation. Chronic repetitive rectal manipulation should be recognized as a potential etiologic factor in such cases.We report the case of an 82-year-old male who presented with sudden-onset massive rectal bleeding. His medical history was notable for chronic constipation managed by repetitive manual rectal disimpaction over several years, without prior anorectal surgery or acute traumatic injury. Contrast-enhanced computed tomography angiography demonstrated a pseudoaneurysm arising from the distal branch of the left superior rectal artery. Subsequent digital subtraction angiography confirmed the diagnosis and allowed for simultaneous therapeutic intervention. Selective endovascular coil embolization was successfully performed, resulting in immediate hemostasis without procedure-related complications.The patient’s post-procedural course was uneventful, and no recurrent bleeding or additional complaints were observed during the 4-month follow-up period. This case highlights chronic repetitive rectal trauma as an underrecognized etiologic factor in the development of superior rectal artery pseudoaneurysm. It also emphasizes the importance of considering vascular causes in patients presenting with unexplained lower gastrointestinal bleeding and supports endovascular embolization as a safe, minimally invasive, and effective treatment option.